Allergic and Nonallergic Rhinitis: Can We Find the Differences/Similarities between the Two Pictures?

Abstract

The diagnostic challenge of rhinitis is to determine the etiology, specifically whether it is allergic or nonallergic. We therefore evaluated the general features of patients with allergic (AR) and nonallergic rhinitis (NAR), as well as health-related quality of life (HRQoL). The study group consisted of 323 patients (201 F/122 M) with a mean age of 31.79 +/- 12.64 years. Almost two thirds of the population had AR (63.5%). Neither the demographic characteristics nor the duration of rhinitis was different between the two groups. Total immunoglobulin E was significantly higher in AR. Although both groups displayed a mild-intermittent rhinitis profile, patients with AR had more seasonal and NAR had more perennial symptoms (p = 0.01). Frequency of nasal obstruction was comparable in both groups, whereas patients with AR significantly complained of rhinorrhea (86.8%), followed by nasal obstruction, sneezing, and nasal itching compared with the NAR group. Conjunctivitis and sinusitis were more prominent in the AR than NAR group (p = 0.01). However, the prevalences of asthma and bronchial hyperreactivity were not different, as well as the other allergic or systemic comorbidities. Furthermore, the impairment in HRQoL was similar in both groups, using a generic questionnaire- Short form-36 (SF-36). In conclusion, although the allergy test results still remain the only relevant difference, the diagnosis of NAR is important as it has many differences/similarities with AR and is seen almost half as often as AR in patients with chronic rhinitis.

Contribution of Neurogenic and Allergic Ways to the Pathophysiology of Nonallergic Rhinitis

“…Even though itching, sneezing and nasal obstruction were reported to be more common in atopic patients, rhinorrhea and nasal obstruction were found to be frequent symptoms of NAR, aside from the major symptoms of neurogenic activation found in other studies [3,5,21,22]. Other than symptoms, we used NIPF as an objective tool of nasal airflow and found that it was compatible with the symptom of nasal obstruction, as reported before [23].…”

“…As mentioned in the World Allergy Organization guideline, the diagnosis of NAR implies exclusion of rhinosinusitis, mechanical/anatomical abnormalities as well as of concomitant diseases as causes of rhinitis symptoms [2]. Even though NAR is at least as common as allergic rhinitis (AR) [3,4], its mechanism is not clear, and it has been suggested to be a local allergic or a neurogenic response.…”

Comparison of Orally Exhaled Nitric Oxide in Allergic versus Nonallergic Rhinitis

“…18 As was shown in our recent study, NAR was around one-fifth of the population with chronic rhinitis. 19 In our present study, higher asthma comorbidity in NAR patients may have been responsible for the insignificant difference compared with AR, using a validated marker of asthma-related inflammation, FeNO. Previous studies showed that those with rhinitis and asthma had significantly higher FeNO values compared with those without asthma.…”

The Prevalence of Allergic Diseases and Associated Risk Factors in School-Age Children and Adults in Erzurum, Turkey

“…This suggests that most of the complaints of rhinitis can be associated with non-allergic causes. While two-thirds of rhinitis cases are actually allergic [8,9,22], about one-fifth of rhinitis cases are allergic in Erzurum, which might be because Erzurum is one of the coldest and highest-altitude cities in Turkey. The lower rate of allergic rhinitis can be explained by the decreased amount of house dust mites and pollen in high altitudes, in addition to the frequent occurrence of respiratory tract infections in cold weather.…”